# Patient-Centered Stewardship to Improve Antibiotic Use in Ambulatory Care

> **NIH AHRQ R01** · NORTHWESTERN UNIVERSITY · 2023 · $500,000

## Abstract

Background: Antibiotic overuse threatens patient safety by causing adverse effects and threatens
the effectiveness of antibiotics through the development of antibiotic resistance. Although our
research team and others have been successful in improving antibiotic prescribing during office visits
using behavioral economics and communication strategies, the improvements have generally been
modest and generally focus on clinician behavior. Patient-directed interventions have usually been
visit-based, educational, and generic. We have written about a need for patient-centered
stewardship, which would use a theory-informed approach to engage directly with high-
inappropriate-antibiotic-utilizing patients outside of visits about their own concerns and behavior.
Research Strategy: To understand and address high-inappropriate patient antibiotic use, we will
conduct a mixed-methods project including controlled cohort studies, qualitative analyses, and a pilot
randomized controlled trial (RCT) of a patient-centered behavioral nudge. Specific Aim 1 is to
perform retrospective, patient-focused, controlled cohort studies of adults and children in 2 health
systems (over 1.5 million patients) to categorize high-antibiotic-use as appropriate, partially
appropriate, potentially appropriate, and inappropriate. Specific Aim 2 is to conduct qualitative
interviews with high inappropriate-antibiotic-utilizing patients to identify social and behavioral factors
that influence care-seeking and antibiotic use, informed by the Theoretical Domains Framework
(TDF) framework. Specific Aim 3 is to – based on findings from Aims 1 and 2 – develop, refine, and
evaluate in a controlled pilot RCT the impact of a patient-centered stewardship behavioral nudge
intervention to reduce inappropriate antibiotic use among high-antibiotic-utilizing patients. The primary
outcome will be the number of inappropriate antibiotic prescriptions over 8 months. Secondary
outcomes will include non-antibiotic medication prescribing, implementation outcomes (feasibility and
acceptability), spillover effects, and unintended consequences.
Implications and Future Directions: We seek to understand and intervene on patient care-seeking
and inappropriate antibiotic use. This project will lay the groundwork for a future, larger RCT testing
the effectiveness of components of the intervention in a broader patient population. The ultimate
goals of this project and subsequent interventions and evaluations are to better understand patient
concerns, care-seeking, and antibiotic use; enable effective engagement with care; improve
diagnostic accuracy; and ensure antibiotic prescribing quality to improve patient safety, decrease
adverse drug events, and limit the spread of antibiotic resistant bacteria.

## Key facts

- **NIH application ID:** 10801756
- **Project number:** 1R01HS029328-01A1
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Jeffrey A. Linder
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2023
- **Award amount:** $500,000
- **Award type:** 1
- **Project period:** 2023-09-30 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10801756

## Citation

> US National Institutes of Health, RePORTER application 10801756, Patient-Centered Stewardship to Improve Antibiotic Use in Ambulatory Care (1R01HS029328-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10801756. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*